Provider Demographics
NPI:1407496854
Name:JANOSIK, DIANE LILAJOYCE (PA-C)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LILAJOYCE
Last Name:JANOSIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 KIDSPEACE DR
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-2098
Mailing Address - Country:US
Mailing Address - Phone:215-290-4543
Mailing Address - Fax:
Practice Address - Street 1:5300 KIDSPEACE DR
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2098
Practice Address - Country:US
Practice Address - Phone:215-290-4543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005160363A00000X
PAMA061226363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant